Preventive medical tests for pilots: complete pre-exam guide

Which preventive medical tests should pilots do before the aeromedical examination? It is one of the questions every pilot asks themselves a few weeks before revalidation. The short answer: the baseline set is clearly defined by EASA Part-MED — but the preventive medical tests for pilots that you do in advance, before walking into the AME’s office, make the difference between a one-hour exam and a deferred file that drags on for weeks. This article explains exactly which preventive medical tests for pilots are mandatory, which are recommended, and how the list changes with age and certificate class.

Why preventive medical tests for pilots matter

The AME (Aero-Medical Examiner) checks, at every exam, a set of biological and physiological markers used to quantify the risk of in-flight incapacitation. Many of the conditions that lead to limitations — hypertension, diabetes, dyslipidaemia, hypothyroidism, hearing loss — have a long asymptomatic phase. A preventive medical test for a pilot is, in effect, an insurance policy: you detect early, intervene through medication or lifestyle change, arrive at the exam with normal values and obtain the certificate without limitations.

For context on common chronic conditions, see also our article on chronic conditions and the pilot medical certificate. For what happens if a parameter is above threshold, see pilot medical certificate limitations.

The standard set of preventive medical tests for pilots

Per Part-MED MED.B.005-035 and the related AMC1, the EASA aeromedical examination implicitly includes a minimum set of tests, regardless of age or certificate class. They group into three main categories.

The three main categories of preventive medical tests for pilots.

Cardiovascular tests. Resting ECG, blood pressure measurement (with 24-hour ambulatory monitoring if needed), assessment of cumulative cardiovascular risk factors. Recommended preventively: full lipid profile (LDL, HDL, triglycerides, total cholesterol), fasting glucose and HbA1c.

Metabolic and blood tests. Glycaemia, haemoglobin, haematocrit, urinalysis (looking for glucosuria, proteinuria, leucocyturia). Recommended preventively: TSH (thyroid function), transaminases (AST, ALT), serum creatinine, complete blood count, ferritin.

Sensory tests. Visual acuity with and without correction, colour vision (Ishihara test, anomaloscope, CAD test), visual field (at the initial examination), pure-tone audiometry (250–8000 Hz, at the initial examination for class 1).

Frequency of mandatory tests by age

EASA sets the frequency of certain tests by age, for class 1. Here is how it applies in practice:

Required ECG and audiogram frequency by age category (class 1).

• ECG: at the initial exam for all classes. For class 1 — repeat every 5 years under age 30, every 2 years between 30 and 39, annually from 40 onwards.
• Pure-tone audiometry: at the initial exam. Repeat every 5 years under age 40, every 2 years over 40.
• Lipid profile and glycaemia: at the initial exam; recommended annually from age 40 onwards.
• Full ophthalmological examination (by an ophthalmologist): at the initial exam for class 1, then every 5 years or whenever the AME requests RXO.

Additional tests by risk category

Beyond the standard set, there are preventive medical tests for pilots that your AME may request — or that are worth doing proactively — depending on your personal or family history.

• Family cardiovascular history: SCORE2 assessment, possibly resting echocardiography, coronary artery calcium score (CAC).
• Personal history of hypertension: 24-hour ambulatory blood pressure monitoring (Holter ABPM), possibly stress test.
• Diabetes or pre-diabetes: HbA1c, fasting glucose, possibly an oral glucose tolerance test (OGTT).
• Suspected sleep apnoea: STOP-BANG questionnaire, polygraphy or polysomnography as appropriate.
• Age over 50: PSA (in men), colorectal screening (FOBT, colonoscopy as appropriate), bone density assessment.

Differences between class 1, class 2 and LAPL

The standard set is broadly the same for all EASA classes, but there are important differences in stringency and frequency. For class 1, requirements are stricter (mandatory pure-tone audiometry at the initial, annual ECG from age 40), and deferrals are more frequent. For class 2 and LAPL, exams are less invasive: no pure-tone audiometry required at initial, ECG less frequent (every 2 years under 50, annually over 50), and the GP report is usually sufficient where class 1 requires a specialist report.

Results that can trigger a deferral and how to anticipate them

Certain values, if discovered for the first time at the aeromedical exam, prevent the certificate from being issued that day. You can anticipate them by doing your preventive medical tests as a pilot 4–6 weeks before the exam.

• Blood pressure > 160/95 mmHg: AME cannot issue the certificate. Solution: home ambulatory monitoring, treatment adjustment with your treating physician.
• Fasting glucose > 126 mg/dL: suspected diabetes, requires confirmation with HbA1c and OGTT.
• LDL > 190 mg/dL: major cardiovascular risk, recommendation for lipid-lowering treatment and re-assessment.
• Audiogram with loss ≥ 35 dB at 500/1000/2000 Hz: mandatory ENT assessment, possible HAL.
• Visual acuity below 6/9 with best correction: additional ophthalmological assessment, possible VDL.

Optimal scheduling: the 45-day rule

For preventive medical tests for pilots to be useful, they must be done with sufficient lead time before the exam. Practical recommendation: schedule the AME exam at least 45 days before your certificate expires. With 6–8 weeks to go, do the preventive tests (the standard set plus those required by your history). If any value is out of range, you have time to intervene medically (treatment, additional investigations, specialist report) without the risk of running out of valid certificate during a reactive booking.

Frequently asked questions about preventive medical tests for pilots

Can I do the tests at any laboratory? Yes, as long as the lab is accredited and the report has the lab letterhead, the doctor’s stamp and signature. The AME may require a repeat at a specific lab only if results are borderline or raise questions.

How recent must the results accepted by the AME be? As a rule, no older than 30 days for blood tests, 90 days for ECG (without clinical change), 6 months for specialist reports (cardiologist, ophthalmologist, ENT).

Can I refuse an additionally requested test? Technically yes, but the AME will issue a deferral for insufficient data, and the certificate will be blocked until completion.

Conclusion

Preventive medical tests for pilots are not a formality: they buy you peace of mind for the next 1–2 years of flying. Knowing the standard set, anticipating borderline values, and scheduling 45 days ahead of the exam significantly reduce the risk of receiving a deferral or an avoidable limitation.

How LaMed Clinic helps with your preventive medical tests

The article gives the general framework, but the exact list of preventive medical tests for pilots depends on your history, age, certificate class and the air operator you fly with. At LaMed Clinic you receive a personalised list adapted to your case.

Specifically, through the LaMed Clinic contact form you can get:

• A personalised list of recommended tests depending on age, certificate class and your medical history.
• Recommendations for laboratories recognised by AMEs and AeMCs in Romania.
• Preliminary interpretation of results before the aeromedical exam, to anticipate any deferrals.
• Support for specialist reports — what to ask the cardiologist, ophthalmologist, ENT specialist, in the format required by PAC-MED.

All requests are handled confidentially. A single message via the contact page is enough.

Official sources and references

1. EASA — Easy Access Rules for Medical Requirements (Part-MED), consolidated online publication.

2. EASA — AMC and GM on the medical certification of pilots (Decision 2011/015/R).

3. UK CAA — Initial Class 1 medical examination (full requirements).

4. Romanian aeromedical authority — Aviation Medicine page (list of AMEs / AeMCs).

5. EUR-Lex — Regulation (EU) No 1178/2011.

Disclaimer

This material is informative and educational in nature. It does not constitute medical advice, an aeromedical opinion or an official interpretation of Part-MED. The decision regarding fitness to fly and interpretation of test results belongs exclusively to an authorised AME / AeMC. EASA regulations are updated periodically; always check the version in force.